摘要
目的观察比较3种麻醉方法在痔疮不同术式中的麻醉效果,为临床麻醉方式的选择提供依据。方法选取痔疮手术患者180例,随机分为两组,Ⅰ组为痔单纯切除术、痔环形切除术、血栓外痔剥离术手术组,Ⅱ组为痔上黏膜环切术(PPH)手术组。Ⅰ、Ⅱ两组再各分为3个小组,Ⅰa、Ⅱa小组均为低位硬膜外阻滞组,Ⅰb、Ⅱb小组均为骶麻组,Ⅰc、Ⅱc小组均为腰-硬联合阻滞组,每小组30例。观察比较这3种麻醉方法在不同术式的痔疮手术中的麻醉效果。结果单纯切除术、痔环形切除术、血栓外痔剥离术时,3种麻醉方法均能顺利完成手术;手术方式为PPH时,低位硬膜外阻滞和骶管阻滞会发生阻滞不全,击发吻合器时患者出现疼痛反应及牵拉不适。而腰-硬联合阻滞则能达到良好的麻醉效果。结论手术部位在齿状线以下时,3种麻醉方法均顺利完成手术,其中以骶麻有优势;而PPH手术时需选择腰硬联合阻滞,才能达到良好的麻醉效果。
Objective To observe and compare anesthetic effect of three types of anesthetia in different surgical methods for hemorrhoids,thus to provide evidence for the selection of clinical anesthesia.Methods One hundred and eighty cases of hemorrhoids surgery were randomly assigned to two groups.Group Ⅰ was given hemorrhoid simple excision,hemorrhoid ring resection and thrombotic external hemorrhoids dissection.Group Ⅱ was given PPH surgery.Group Ⅰ and Ⅱ were further divided into three subgroups.Group Ⅰa and Ⅱa were given low epidural anesthesia,group Ⅰb and Ⅱb were given caudal anesthesia and group Ⅰ c and Ⅱ c were given waist and epidural anesthesia.There were 30 patients in each subgroup.Anesthetic effect of the three types of anesthesia were observed and compared.Results The three anesthetic methods could successfully complete the surgery in simple excision,hemorrhoid loop excision or dissection of thrombotic external hemorrhoids;for surgical site above the dentate line（PPH）,epidural block and sacral block might be incomplete,thus patients might have pain response and traction discomfort when firing stapler.Spinal-epidural block could achieve good effects of anesthesia in all conditions.Conclusion For surgical site below the dentate line,three anesthetic methods can facilitate successful surgery,among which caudal anesthesia have the most advantages.For PPH surgery,lumbar epidural block anesthesia need to be selected in order to achieve good results.
出处
《中国当代医药》
2012年第35期87-88,共2页
China Modern Medicine
关键词
痔疮
术式
麻醉方法
骶麻
低位硬膜外阻滞
腰-硬联合阻滞
Hemorrhoids
Surgical methods
Anesthesia
Caudal anesthesia
Epidural block
Spinal-epidural block
